[Primary spinal epidural abscess - a case report]

Spinal epidural abscess is a rare affection in child. Bacteria gain access to the epidural space through contiguous spread or hematogenous dissemination. It is more common in thoracolumbar than cervical areas. The organisms most frequently encountered are Staphylococcus aureus. Back pain, fever and neurologic deficit are the three most common symptoms. MRI is the imaging method of choice in diagnosing spinal epidural abscess. Surgical drainage with systemic antibiotics is the treatment of choice. We report the case of a 8 years old children, without any pathological antecedent, hospitalized in the service of Pediatrics for back pain, fever and lameness. The clinical examination found a lumbar rachis painful to the palpation with limited mobility, there was no neurologic deficit. Laboratory investigations showed that inflammatory markers were uniformly elevated. MRI showed a spinal epidural abscess in L3-L4. No micro-organism was isolated in blood cultures. A diagnosis of spinal epidural abscess was suspected and a medical treatment was indicated for 3 months. The outcome was favorable. On the light of this observation, the authors make a review of literature

[Incidence of pediatric nosocomial infection in Bizerte district: results of 3 months survey]

Children nosocomial infections are different than adult's according some criteria that makes necessary to conduct a special kind of surveillance program, which is specific to this category. In Tunisia, there are so few data available related to such hospital infections frequencies in paediatric services. In Bizerta region, the only survey on paediatric nosocomial infection was held in the beginning of the 90s. Recently a specific surveillance system for children was held there. The output of such system is able to provide a lot of information, according new cases [incidence], main criteria and risk factors. Because of practical matters, mainly feasibility, we've chosen to use repetitive periodic surveys as measurement method. This paper is reporting the first step of the study conducted in 2005 [called NOSOBIPED05] and concerning the two paediatric services of the region for three months [from 1[st] October to 31[st] December 2005]. A total of 860 sick children were concerned by the study, including 525 [61%] male and 335 female [39%]. Two hundred and eighty eight [288] of them were under one month age [33.5%] and 424 [49.3%] were more than one year. Perinatal pathologies were the first hospitalization diagnosis [267 cases], followed by respiratory illnesses [139 cases]. The average of the hospital stay was 4.9 days [with 0 and 46 days as extremes]. In our population study, there were so few intrinsic and extrinsic risk factors: diabetes [1.0%], malnutrition [0.6%], immune depression [0.5%], mechanic ventilation [0.2%]. But the use of peripheral vascular catheters was frequently found [52.8%]. Among the 860 sick children, only 705 were concerned by the academic definition of nosocomial infection [155 had stayed less than 48 hours]. The total number of nosocomial infection was 25, then 3.5 per 100 hospitalizations. That means 6.0 infections per 1000 patient-days density of incidence [reported to the number of days stay for the 705 concerned sick children]. No one case of infection was positive [14 negative bacterial researches were held]. Respiratory infections were the most commune location [68%] [17/25]. These results must be used by concerned services to improve prevention. More surveillance steps have to be continued in the next years, to better understand the epidemiology of those special paediatric infections in Bizerta region

[Cleido-cranial dysplasia: a family observation]

Cleido-cranial dysplasia is a rare autosomal dominant skeletal dysplasia characterised by hypoplastic clavicles, macrocephaly with patent fontanelles, persistant open sutures, short stature and tooth anomalies.We report a family observation of two children, brother and sister respectively aged of 6 and 8 years. The wide coronal and lambdatic sutures, still open anterior fontanelle and the absence of right clavicle confirm the diagnosis of cleido-cranial dysplasia

[Fanconi's anemia with early onset a case report]

Fanconi's anemia [LA] is a rare autosomal recessive disease characterized by the association of progressive pancytopenia, congenital abnormalities and predisposition to cancer. Usually, diagnosis is made at school age. Exceptionally, the desease may occur early since the neonatal period. We report a case of Fanconi's anemia with early onset at an infant aged of ten months who presented with congenital malformations: microcephaly, triangular face, bilateral radial defects, renal and genital abnormalities. At the age of 10 months, the patient developed brownish spots and a pancytopenia. The diagnosis of FA is confirmed by bone marrow biopsy and cytogenetic study. The patient died at the age of 14 months by septic shock. The possibility of early onset of BA anemia must consider this diagnosis in every case of aplastic anemia regardless of the age even in the absence of typical congenital abnormalities

[ splenic angioma in children: a case report]

The splenic angioma is a rare benign tumor, not very symptomatic and often of fortuitous discovery. The surgical treatment is essential for the bulky lesions which involve a significant risk of rupture and hemoperitonium. We report the observation of a eight years old girl at which the splenic angioma was discovered in a fortuitous way at the time of an ultrasonography required in the assessment of a urinary tract infection. The abdominal computed tomography scan confirmed the diagnosis by showing an hypodense lesion well limited with intense raising aftercontrast injection. The fear of a rupture made pose the indication of a partial splenectomy with simple continuations

Under hepatic appendicitis complicated by peritonitis and under hepatic abcess - about a case report

Appendicitis in the child under 3 years old is rare and often arises in a serious and complicated form considering the delay of diagnosis. Its localization is sometimes ectopic and the clinical signs are often misleading. The diagnosis primarily rests on the clinical examination. Abdominal echography and the tomodensitometry are reserved for the diagnostic doubts, we bring back the observation of a 2 year and 9 months old girl which consulted for acute abdominal pain, fever and stop of the matters. The clinical examination showed an abdominal distension with diffuse sensitivity. Abdominal echography was normal. The biological exams objectivated an hyperleucocytosis with polynucleosis. The patient was kept under surveilance the evolution was done towards the persistence of the fever and the installation of a liquid diarrhoea making carry the diagnosis of acute gastro-enteritis. After 5 days of hospitalization, apparition of an abdominal defense generalized with saddles striated with blood the abdomen radiography showed grelic hydroaeric levels and echography revealed the presence of an under hepatic collection. The post-operative evolution was good. In the light of this observation, the authors make a review of the literature while insisting on the diagnostic difficulties of appendicites of the child

cystic dilatation of choledoque. A case report

The cystic dilation of choledoque is a rare congenital affection. It represents the first cause of extra hepatic cholestase in child. The discovery is generally made in childhood. The diagnosis rests primarily on echography. Because of the secondary risk of degeneration of the cyst and its complications, the complete surgical resection is essential. We report the case of an infant of female sex admitted in our service at the age of 11 months for abdominal distension, fever, icter and melena. The clinical examination found an supra-umbilical mass. Radiological explorations [echography, scanner and IRM] were in favour of a pseudo cyst of the choledoque. The treatement consisted on an exeresis of the cyst followed with bilio-digestive and ilio-jejunal anastomosis. The post-operative evolution was simple. At the occasion of this observation, the authors make a review of literature

[Crossed renal ectora : a two cases report]

Crossed renal ectopia is a rare congenital anomaly, in which, the two kidneys are in the same side with one of the ureters which crosses the midline to be brought together in the bladder on the opposite side. Generally asymptomatic and of fortuitous discovery, this anomaly can appear by abdominal pains, urinary tract infection or a hematuria. The diagnosis rests on the radiological examinations in particular the ultrasonography, the intravenous urography and the CT scann. The treatment is surgical and is reserved for the complicated forms. We report two observations of children with a crossed renal ectopia The first observation is that of a 5 years old girl, presenting urinary tract infections at repetition whose etiologic assessment comprising a renal ultrasonography, a voiding cystourethrography as well as a three-dimensional tomodensitometry objectified a vesico-ureteral reflux grade HI, on left kidney in crossed ectopia. After sterilization of the urines, this patient profited from a surgical cure of her left vesicoureteral reflux with simple continuations.The second observation concerns a 10 years old boy, carrying a malformation anorectale, operated at birth, and at which the malformatif assessment [renal ultrasonography, vertebral radiography] objectified a left kidney in crossed ectopia with vesicoureteral ipsilateral reflux grade Ill associated with complex vertebral anomalies. This child was operated according to the same technique with simple operational continuations. From these two observations and after review of the literature, we recall the clinical, radiological and therapeutic characteristics of this malformation and discuss the pathogenic assumptions